We demonstrated that LAT was a univariate risk factor associated with worse cardiovascular outcomes, which was observed in 8.8% of patients with sub-therapeutic anticoagulation and 3.6% of patients with sufficient anticoagulation.

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BackgroundRemote ischemic conditioning (RIC) is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF) with reduced left ventricular ejection fraction. Coronary flow reserve (CFR) is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE). This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE.MethodsTen patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment.ResultsOne week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0±0.9 to 4.6±1.3 (mean ± standard deviation) in healthy subjects (P=0.02), and from 1.9±0.4 to 2.3±0.7 in patients with HF (P=0.03), respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01).ConclusionThis study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction.

Advances in electronic miniaturization and digital techniques have resulted in the advent of portable transthoracic echocardiography (pTTE) imaging devices in the area of echocardiography. A pocket-sized pTTE imaging device that has color Doppler imaging capability has been recently introduced into clinical practice. This study aimed to examine the feasibility and accuracy of the pocket-sized pTTE in the assessment of the severity of mitral regurgitation (MR) and tricuspid regurgitation (TR).One hundred and eighty-six consecutive patients (ages 66 Ϯ 19 years; 107 male) underwent standard transthoracic echocardiography (sTTE) and pTTE. Initially, pTTE was performed by a well-trained sonographer for 121 patients. For the later 65 patients, pTTE was examined by a less experienced sonographer who had 6 months of experience in echocardiography, with the number of TTE examinations compatible with American Society of Echocardiography training level 1 (1). These sonographers were blinded to sTTE results and all clinical information.This study was approved by the ethics committees of Osaka Ekisaikai Hospital and Okayama University. Pocket-sized pTTE was performed using the Vscan (GE Medical Systems, Milwaukee, Wisconsin). The apical 4-chamber view by the color Doppler images was obtained with sTTE and pTTE, respectively. The ratio of regurgitant jet area to atrial area was then calculated for MR (%MR) and TR (%TR). The severity of regurgitation was graded as mild if it occupied Ͻ20%, moderate if between 20% and 34%, and severe if Ͼ34% in TTE examination.Linear regression analysis was used for the correlation of variables of interest. Differences were considered significant at p Ͻ 0.05. Differences between sTTE and pTTE results were also compared with the mean value obtained by sTTE and pTTE using the Bland-Altman method, with the limits of agreement defined as Ϯ 2 SD of the difference between the 2 methods.Echocardiographic measurements were completed for sTTE and pTTE in all patients (feasibility 100%). In the examination by the well-trained sonographer, there were excellent correlations in MR jet area, left atrial area, %MR, TR jet area, right atrial area, and %TR between sTTE and pTTE (r ϭ 0.89 to 0.96, p Ͻ 0.001). Also, there were small systematic differences with close limits of agreement between sTTE and pTTE measurements, respectively: Ϫ0.2 cm 2 and 1.5 cm 2 for MR jet area; Ϫ0.4 cm 2 and 4.6 cm 2 for left atrial area; Ϫ0.5 cm 2 and 5.6 cm 2 for %MR; Ϫ0.2 cm 2 and 2.3 cm 2 for TR jet area; 0.0 cm 2 and 4.2 cm 2 for right atrial area; and Ϫ1.2 cm 2 and 8.9 cm 2 for %TR. The sensitivity and specificity of pTTE for detecting more than moderate MR were both 96%. The sensitivity and specificity of pTTE for detecting more than moderate TR were 94% and 96%, respectively. In patients with more than moderate regurgitation, the evaluation of the etiology of MR and TR by pTTE was the same as for those with sTTE.In the examination with the less experienced sonographer, the correlations between sTTE and pTTE were slightly reduc...

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